HESI - MEDICAL SURGICAL NURSING TEST TEST BANK WITH
200 REAL EXAM PRACTICE QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
Controlling pain is important to promoting wellness. Unrelieved pain has been associated with
a. prolonged stress response and a cascade of harmful effects system wide.
b. decreased tumor growth and longevity
c. large tidal volumes and decreased lung capacity
d. decreased carbohydrate, protein, and fat destruction - CORRECT ANSWERS-A
Pain triggers a number of physiologic stress responses in the human body. Unrelieved pain can prolong
the stress response and produce a cascade of harmful effects in all body systems. The stress response
causes the endocrine system to release excessive amounts of hormones, such as cortisol,
catecholamines, and glucagon. Insulin and testosterone levels decrease. Increased endocrine activity in
turn initiates a number of metabolic processes, in particular, accelerated carbohydrate, protein, and fat
destruction, whcih can result in weight loss, tachycardia, increased respiratory rate, shock, and even
death. The immune system is also affected by pain as demonstrated by research showing a link between
unrelieved pain and a higher incidence of nosocomial infections and increased tumor growth. Large tidal
volumes are not associated with pain while decreased lung capacity is associated with unrelieved pain.
Decreased tumor growth and longevity are not associated with unrelieved pain. Decreased carbs,
protein, and fat are not associated with pain or stress response.
Which intervention in a client with dehydration induced confusion is most likely to relieve the confusion?
a. increasing the IV flow rate to 250 mL/hr
b. applying oxygen by mask or nasal cannula
c. placing the client in a high Fowler's position
d. Measuring intake and output every four hours - CORRECT ANSWERS-A
Dehydration most frequently leads to poor cerebra perfusion and cerebral hypoxia, causing confusion.
Applying oxygen can reduce confusion, even if perfusion is still less than optimum. Increasing the IV flow
rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the
person too rapidly with IV fluids can lead to cerebral edema.
Which client is at greatest risk for dehydration?
,a. younger adult client on bedrest
b. older adult client receiving hypotonic IV fluid
c. older adult client with cognitive impairment
d. younger adult client receiving hypertonic IV fluid - CORRECT ANSWERS-C
Older adults, because they have less total body water than younger adults, are at greater risk for
development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids
independently or cannot make his or her need for fluids known is at high risk for dehydration
A nurse is caring for several clients. Which client does the nurse assess most carefully for hyperkalemia?
a. client with type 2 diabetes taking an oral anti-diabetic agent
b. client with heart failure using a salt substitute
c. client taking a thiazide diuretic for hypertension
d. client taking non-steroidal anti-inflammatory drugs daily - CORRECT ANSWERS-B
Many salt substitutes are composed of potassium chloride. Heavy use cna contribute to the
development of hyperkalemia. The client should be taught to read labels and to choose a salt substitute
that does not contain potassium. NSAIDs promote the retention of sodium but not potassium.
An older adult client presents with signs and symptoms related to dig toxicity. Which age related change
may have contributed to this problem?
a. decreased renal blood flow
b. increased gastrointestinal motility
c. decreased ratio of adipose tissue to lean body mass
d. increased total body water - CORRECT ANSWERS-A
Decreased renal blood flow and reduced glomerular filtration can result in slower medication excretion
time, potentially leading to toxic drug accumulation. Aging results in decreased total body water and
,gastrointestinal motility and an increase in the ratio of adipose tissue to lean body mass, but is not
related to dig toxicity.
A client is being treated for dehydration. Which statement made by the client indicates understanding of
this condition?
a. I will use a salt substitute when making and eating my meals.
b. I must drink a quart of water or other liquid each day.
c. I will not drink liquids after 6 PM so I won't have to get up at night.
d. I will weigh myself each morning before I eat or drink. - CORRECT ANSWERS-D
Because 1 L of water weighs 1 kg, change in body weight is a good measure of excess fluid loss or fluid
retention. Weight loss greater than 0.5 lb daily is indicative of excessive fluid loss. The other statements
are not indicative of practices that will prevent dehydration.
The nurse notes that the handgrip of the client with hypokalemia has diminished since the previous
assessment one hour ago. Which intervention by the nurse is the priority?
a. assess the client's respiratory rate, rhythm, and depth
b. document findings and monitor the client
c. measure the client's pulse and blood pressure
d. call the health care provider - CORRECT ANSWERS-A
In a client with hypokkalemia, progressive skeletal muscle weakness is associated with increasing
severity of hypokalemia. The most life-threatening complication of hypokalemia is respiratory
insufficiency. It is imperative for the nurse to perform a respiratory assessment first to make sure that
the client is not in immediate jeopardy. Next, the nurse would call the health care provider to obtain
orders for potassium replacement.
The physician orders Lasix (furosemide) 60 mg po every day for your patient. On hand you have Lasix 40
mg. How many tablets will you give the patient?
, a. 3
b. 1
c. 1 1/2
d. 2 1/5 - CORRECT ANSWERS-C
60/40 (desired/have)
A client has been taught to restrict dietary sodium. Which food selection by the client indicates to the
nurse that teaching has been effective?
a. a grilled cheese sandwich with tomato soup
b. Chinese take-out, including steamed rice
c. a chicken leg, one slice of bread with butter, and steamed carrots
d. slices of ham and cheese on whole grain crackers - CORRECT ANSWERS-C
Clients on restricted sodium diets generally should avoid processed, smoked, and pickled foods and
those with sauces and other condiments. Foods lowest in sodium include fish, poultry, and fresh
produce. The chinese food likely would have soy sauce, the tomato soup is processed, and the crackers
are a snack food - a category of foods often high in sodium.
When a client is assessed, which behavior best indicates that he or she is experiencing changes
associated with acute pain?
a. inability to concentrate
b. expressed hopelessness
c. psychosocial withdrawal
d. anger and hostility - CORRECT ANSWERS-A
The characteristics most common to chronic pain are psychosocial withdrawal, anger and hostility,
depression, and hopelessness. The inability to concentrate is associated much more with acute pain,
before any physiologic or behavioral adaptation has occurred.
200 REAL EXAM PRACTICE QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
Controlling pain is important to promoting wellness. Unrelieved pain has been associated with
a. prolonged stress response and a cascade of harmful effects system wide.
b. decreased tumor growth and longevity
c. large tidal volumes and decreased lung capacity
d. decreased carbohydrate, protein, and fat destruction - CORRECT ANSWERS-A
Pain triggers a number of physiologic stress responses in the human body. Unrelieved pain can prolong
the stress response and produce a cascade of harmful effects in all body systems. The stress response
causes the endocrine system to release excessive amounts of hormones, such as cortisol,
catecholamines, and glucagon. Insulin and testosterone levels decrease. Increased endocrine activity in
turn initiates a number of metabolic processes, in particular, accelerated carbohydrate, protein, and fat
destruction, whcih can result in weight loss, tachycardia, increased respiratory rate, shock, and even
death. The immune system is also affected by pain as demonstrated by research showing a link between
unrelieved pain and a higher incidence of nosocomial infections and increased tumor growth. Large tidal
volumes are not associated with pain while decreased lung capacity is associated with unrelieved pain.
Decreased tumor growth and longevity are not associated with unrelieved pain. Decreased carbs,
protein, and fat are not associated with pain or stress response.
Which intervention in a client with dehydration induced confusion is most likely to relieve the confusion?
a. increasing the IV flow rate to 250 mL/hr
b. applying oxygen by mask or nasal cannula
c. placing the client in a high Fowler's position
d. Measuring intake and output every four hours - CORRECT ANSWERS-A
Dehydration most frequently leads to poor cerebra perfusion and cerebral hypoxia, causing confusion.
Applying oxygen can reduce confusion, even if perfusion is still less than optimum. Increasing the IV flow
rate would increase perfusion. However, depending on the degree of dehydration, rehydrating the
person too rapidly with IV fluids can lead to cerebral edema.
Which client is at greatest risk for dehydration?
,a. younger adult client on bedrest
b. older adult client receiving hypotonic IV fluid
c. older adult client with cognitive impairment
d. younger adult client receiving hypertonic IV fluid - CORRECT ANSWERS-C
Older adults, because they have less total body water than younger adults, are at greater risk for
development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids
independently or cannot make his or her need for fluids known is at high risk for dehydration
A nurse is caring for several clients. Which client does the nurse assess most carefully for hyperkalemia?
a. client with type 2 diabetes taking an oral anti-diabetic agent
b. client with heart failure using a salt substitute
c. client taking a thiazide diuretic for hypertension
d. client taking non-steroidal anti-inflammatory drugs daily - CORRECT ANSWERS-B
Many salt substitutes are composed of potassium chloride. Heavy use cna contribute to the
development of hyperkalemia. The client should be taught to read labels and to choose a salt substitute
that does not contain potassium. NSAIDs promote the retention of sodium but not potassium.
An older adult client presents with signs and symptoms related to dig toxicity. Which age related change
may have contributed to this problem?
a. decreased renal blood flow
b. increased gastrointestinal motility
c. decreased ratio of adipose tissue to lean body mass
d. increased total body water - CORRECT ANSWERS-A
Decreased renal blood flow and reduced glomerular filtration can result in slower medication excretion
time, potentially leading to toxic drug accumulation. Aging results in decreased total body water and
,gastrointestinal motility and an increase in the ratio of adipose tissue to lean body mass, but is not
related to dig toxicity.
A client is being treated for dehydration. Which statement made by the client indicates understanding of
this condition?
a. I will use a salt substitute when making and eating my meals.
b. I must drink a quart of water or other liquid each day.
c. I will not drink liquids after 6 PM so I won't have to get up at night.
d. I will weigh myself each morning before I eat or drink. - CORRECT ANSWERS-D
Because 1 L of water weighs 1 kg, change in body weight is a good measure of excess fluid loss or fluid
retention. Weight loss greater than 0.5 lb daily is indicative of excessive fluid loss. The other statements
are not indicative of practices that will prevent dehydration.
The nurse notes that the handgrip of the client with hypokalemia has diminished since the previous
assessment one hour ago. Which intervention by the nurse is the priority?
a. assess the client's respiratory rate, rhythm, and depth
b. document findings and monitor the client
c. measure the client's pulse and blood pressure
d. call the health care provider - CORRECT ANSWERS-A
In a client with hypokkalemia, progressive skeletal muscle weakness is associated with increasing
severity of hypokalemia. The most life-threatening complication of hypokalemia is respiratory
insufficiency. It is imperative for the nurse to perform a respiratory assessment first to make sure that
the client is not in immediate jeopardy. Next, the nurse would call the health care provider to obtain
orders for potassium replacement.
The physician orders Lasix (furosemide) 60 mg po every day for your patient. On hand you have Lasix 40
mg. How many tablets will you give the patient?
, a. 3
b. 1
c. 1 1/2
d. 2 1/5 - CORRECT ANSWERS-C
60/40 (desired/have)
A client has been taught to restrict dietary sodium. Which food selection by the client indicates to the
nurse that teaching has been effective?
a. a grilled cheese sandwich with tomato soup
b. Chinese take-out, including steamed rice
c. a chicken leg, one slice of bread with butter, and steamed carrots
d. slices of ham and cheese on whole grain crackers - CORRECT ANSWERS-C
Clients on restricted sodium diets generally should avoid processed, smoked, and pickled foods and
those with sauces and other condiments. Foods lowest in sodium include fish, poultry, and fresh
produce. The chinese food likely would have soy sauce, the tomato soup is processed, and the crackers
are a snack food - a category of foods often high in sodium.
When a client is assessed, which behavior best indicates that he or she is experiencing changes
associated with acute pain?
a. inability to concentrate
b. expressed hopelessness
c. psychosocial withdrawal
d. anger and hostility - CORRECT ANSWERS-A
The characteristics most common to chronic pain are psychosocial withdrawal, anger and hostility,
depression, and hopelessness. The inability to concentrate is associated much more with acute pain,
before any physiologic or behavioral adaptation has occurred.
